H34.8190 — Central retinal vein occlusion, unspecified eye, with macular edema
Is H34.8190 billable?
Yes, but H34.8190 will trip a Medicare edit. H34.8190 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists H34.8190 under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
H34.8190 at a glance
| Code | H34.8190 |
|---|---|
| Description | Central retinal vein occlusion, unspecified eye, with macular edema |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "0" | with macular edema |
What does the 7th character "0" mean in H34.8190?
In H34.8190, the 7th character 0 means with macular edema. The 7th character is required for H34.8190 to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to H34.8190?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name H34.8190 directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does H34.8190 group to?
H34.8190 sits in MDC 02 and helps define the logic of 1 MS-DRG (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 123Neurological Eye Disordersmedical
As a secondary diagnosis, H34.8190 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is H34.8190 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under H34.81, the nearest indexed parent of H34.8190. Use them to find the family, then select the specific code.
- Occlusion, occluded › retina, retinal › vein
Excludes1 — never code together — inherited from H34
The conditions below can never be reported together with H34.8190 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- amaurosis fugax (G45.3)
Excludes2 — not included here — inherited from Chapter 7
The conditions below are not part of H34.8190, but a patient may have both at the same time. When documentation supports it, H34.8190 and the excluded code may both be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury (trauma) of eye and orbit (S05.-)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)
How long has H34.8190 existed?
H34.8190 first appears in FY2018 (FY2017 is not available, so it may have appeared then).
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.